26 Tex. Admin. Code § 320.145 - Use of Restraint in Situations Involving Non-Violent, Non-Self-Destructive Behavior
(a) If an
assessment reveals non-violent, non-self-destructive behavior, as defined in
§ 415.253 of this title (relating to Definitions), the facility shall use
the least restrictive intervention that effectively protects the individual
from harm. If the intervention is a restraint as defined in this subchapter, it
shall only be used in the following circumstances:
(1) medically necessary;
(2) ordered by a physician;
(3) needed to ensure the individual's safety;
and
(4) used only after less
restrictive interventions have been considered, or attempted and determined to
be ineffective, or are judged to be unlikely to protect the individual or
others from harm.
(b)
Prior to the application of a restraint for the management of non-violent,
non-self-destructive behavior, an assessment of the individual shall be done to
determine that the risks associated with the use of the restraint are
outweighed by the risks of not using it.
(c) The physician's order for the restraint
shall specify:
(1) a time limit on the use of
the restraint;
(2) any special
considerations for the use of restraint;
(3) the specific type of restraint to be
used;
(4) who is responsible for
implementing the restraint; and
(5)
instructions for monitoring the individual.
(d) The physician shall renew the order as
frequently as determined by facility policy.
(e) The order for the restraint shall be
followed by consultation with the individual's treating physician if the
restraint was not ordered by the individual's treating physician. The
consultation shall be documented in the individual's medical record no later
than the next business day, except that it shall be done sooner, when an
earlier consultation is clinically indicated.
(f) The care of the individual shall be based
on a rationale that reflects consideration of the individual's medical needs
and health status.
(1) If the facility has
made a clinical determination that its use of restraint for the management of
non-violent, non-self-destructive behavior requires a frequency of assessment
or an aspect of care or treatment that differs from the provisions of this
subchapter governing restraint in a behavioral emergency, facility policies and
procedures on the use of restraint for the management of non-violent,
non-self-destructive behavior shall address:
(A) the facility's required frequency of
assessment of the individual during restraint; and
(B) how the individual's circulation,
hydration, elimination, level of distress and agitation, mental status,
cognitive functioning, cardiac functioning, skin integrity, nutrition,
exercise, and range of motion of extremities are to be assessed and addressed
during restraint.
(2) The
plan for monitoring the individual and the rationale for the frequency of
monitoring shall be documented in the individual's medical record.
(g) A dentist at a facility,
including any contractor providing dental services on the facility premises
shall not restrain an individual for dental care or rehabilitation unless the
restraint is ordered by the individual's physician. The dentist shall maintain
a copy of the order in the individual's medical record and shall ensure
compliance with the requirements of the order.
(h) Whenever a restraint is ordered by a
physician, the ordering physician shall prescribe the frequency of assessment
required for the individual during restraint and how the individual's
circulation, hydration, elimination needs, level of distress and agitation,
mental status, cognitive functioning, cardiac functioning, skin integrity,
nutrition, exercise, and range of motion of extremities are to be assessed and
addressed during restraint.
Notes
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No prior version found.